Australians do not pay a dedicated cancer levy. We do not pay a cardiovascular disease surcharge.
But in Victoria and Queensland, taxpayers pay additional levies specifically for mental health. Victoria’s Mental Health and Wellbeing Surcharge raised $1.26 billion in 2024–25. Queensland’s Mental Health Levy raises hundreds of millions more.
Australians also contribute through Medicare, private health insurance premiums and significant out-of-pocket healthcare costs. Yet the latest National Mental Health Report Card tells us something deeply uncomfortable: mental health care is becoming less affordable for the people who need it.
About 4.3 million Australian adults experience a mental health disorder each year. More Australians are presenting to emergency departments with mental health concerns and waiting longer for care. Women and girls are also disproportionately impacted, with the latest National Study of Mental Health and Wellbeing (NSMHW) data showing double the number of women (16%) have been diagnosed with a mental illness, compared with men in the same group (8%). Depressive disorder rates have also increased by 7% for female adolescents while reducing by 2% in young men and overall psychological distress remains 16% higher in women aged 16–24 years than men.
A shared concern expressed in the National Report Card is financial pressure, which remains a major source of stress for one in three people with a mental health condition, compared with one in five without one. People with a mental health condition are twice as likely to experience discrimination. Of most concern, the proportion of people avoiding mental health care because they cannot afford it has risen from 12 to 20 per cent in just three years.
If comparable numbers of Australians with cancer or cardiovascular disease were avoiding specialist treatment because they could not afford it, would we accept it?
Why are we accepting it for mental illness?
Mental illnesses are treatable. People living with schizophrenia, bipolar disorder, severe depression, eating disorders and other serious mental illnesses can benefit enormously from timely, evidence-based treatment.
But treatment is not a single appointment and usually involves several contacts with different health professionals. For many, this looks like a GP appointment, a psychiatric assessment, medication
prescriptions, and psychological therapy, with input from multidisciplinary care teams and specialists that last for months or years. This is where Medicare matters.
For outpatient psychiatric care (ongoing care in hospitals, clinics or doctor’s office not requiring overnight admission), Medicare is effectively the principal funder, as private health insurance does not cover their psychiatric consultations. Unfortunately, Medicare rebates have not kept pace with the real costs of providing specialist psychiatric care.
The consequence is a growing gap between the cost of providing care (and keeping services viable) and what Medicare contributes. Ultimately, patients feel that gap.
Private psychiatrists care for people with significant and complex illnesses, often over many years. But when someone deteriorates and needs intensive multidisciplinary support, community care or urgent hospital admission, a psychiatrist cannot be everywhere for everyone.
The public system needs to step up. Too often, it cannot.
More than 318,000 mental health-related presentations were made to Australian public hospital emergency departments in 2024–25.
Emergency departments provide essential emergency care. But a busy ED is not a good environment for someone experiencing psychosis, mania, severe depression or suicidal distress. It should not become the default place to receive specialist psychiatric care.
For people living with severe mental illness and psychosocial disability, recovery also depends on stable housing and a village of support, from deep social connections to help with daily living, employment or education.
As governments reshape the NDIS, people cannot afford to lose psychosocial supports before properly funded alternatives are available. Unmet need does not disappear – it shifts on to hospitals, homelessness services, families and carers.
Psychiatrists see this firsthand: families becoming de facto case managers, crisis teams, accommodation providers and safety nets because help is unavailable.
The Report Card’s findings on discrimination are telling.
We tend to think of stigma as something individuals do. But discrimination can become structural, almost built into society itself. If people with mental illness repeatedly face unaffordable specialist treatment, fragmented services, prolonged waits and higher access thresholds, we need to ask whether we have simply accepted a lower quality of care.
Australians already invest heavily in our mental health. Dedicated state levies were created to provide additional funding to strengthen mental health systems. Governments owe the community more than an accounting report of how their cash was spent They need to show what changed.
Did people get specialist treatment earlier? Did access to specialists improve? Did community and inpatient capacity grow? Can people access evidence-based treatments and psychosocial support? Are fewer people reaching crisis?
And why, despite substantial investment, does the Report Card show more of us are avoiding mental health care because we cannot afford it?
People living with mental illness aren’t asking for a miracle. They are simply seeking timely, affordable, evidence-based specialist health care and the same standard we’d receive for any other serious illness.
We have the evidence. We are making substantial investments. And mental illnesses are treatable.
The question governments now need to answer is why Australians continue to suffer and pay more, for less.